Serum Vitamin B12 as a Risk Factor and Prognostic Indicator in Acute Ischemic Stroke: A Case-Control Study at a Tertiary Care Hospital Mirpurkhas (Sindh)
Serum Vitamin B12 as a Risk Factor and Prognostic Indicator in Acute Ischemic Stroke
DOI:
https://doi.org/10.54393/pjhs.v6i1.2430Keywords:
Vitamin B12 Deficiency, National Institutes of Health Stroke Scale, Acute Ischemic Stroke, Stroke SeverityAbstract
Ischemic stroke is among the main causes of disability and death globally. Vitamin B12, through its role in homocysteine metabolism, may help prevent stroke, as its deficiency increases stroke risk. Objective: To compare the serum level of vitamin B12 in stroke patients and controls. Methods: The current case-control study was conducted in Mirpurkhas, Sindh, included 75 patients who suffered from stroke and 75 control subjects. Serum level of vitamin B12 and the levels of homocysteine were evaluated, along with the severity of stroke and functional outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS), respectively, at discharge and 28 days. Statistical analysis explored associations with the severity of the stroke and its outcomes. Results: Stroke patients showed significantly lower levels of vitamin B12 (188.4 ± 43.6 pg/mL) than controls (352.7 ± 54.1 pg/mL, p<0.001). Vitamin B12 insufficiency (<200 pg/mL) was more prevalent in stroke patients (65.3%) compared to controls (18.7%, p<0.001). NIHSS scores were higher in deficient patients (13.1 ± 4.2) than those with insufficient (9.6 ± 3.1) or sufficient levels (7.5 ± 2.5, p<0.001). Worse functional outcomes (mRS 3.9 ± 1.2) were noted in deficient patients compared to insufficient (2.8 ± 0.8, p=0.007) and sufficient levels (2.3 ± 0.6, p<0.001). Logistic regression identified vitamin B12 deficiency as an independent stroke risk factor (OR=5.9, 95% CI: 2.9–12.3, p<0.001). Conclusions: It was concluded Vitamin B12 deficiency was associated with increased stroke severity and poorer outcomes, suggesting its potential role in stroke management.
References
Khan A, Memon SH, Saboor R, Mengal A, Memon N, Soomro MA et al. Prevalence of Serum Vitamin-B12 Level and Its Association Among the Patients of Transient Ischemic Attack/Ischemic Stroke. Pakistan Journal of Medical & Health Sciences. 2023 Jun; 17(04): 591-. doi: 10.53350/pjmhs2023174591. DOI: https://doi.org/10.53350/pjmhs2023174591
Bullo N, Aziz A, Afzal M. Frequency of Hyperhomocysteinemia in Young (≤ 45 Years) Patients Presenting with Acute Ischemic Stroke. Pakistan Journal of Medical & Health Sciences. 2023 May; 17(04): 122-. doi: 10.53350/pjmhs2023174122. DOI: https://doi.org/10.53350/pjmhs2023174122
Akter R. Health Related Quality of Life of Stroke Patients After Receiving Rehabilitation Service from Specialized Rehabilitation Centre (Doctoral Dissertation, Bangladesh Health Professions Institute, Faculty of Medicine, The University of Dhaka, Bangladesh).
Malik A, Khan MA, Zehra F, Wasay M, Khan RN. Potential Risk Factors of Stroke: A Community-Based, Cross-Sectional Study from Sindh Province of Pakistan. Khyber Medical University Journal. 2020 Mar; 12(1): 25-8.
Soh Y, Lee DH, Won CW. Association Between Vitamin B12 Levels and Cognitive Function in The Elderly Korean Population. Medicine. 2020 Jul 24; 99(30): E21371. DOI: https://doi.org/10.1097/MD.0000000000021371
doi; 10.1097/MD.0000000000021371.
Yahn GB, Abato JE, Jadavji NM. Role Of Vitamin B12 Deficiency in Ischemic Stroke Risk and Outcome. Neural Regeneration Research. 2021 Mar; 16(3): 470-4. doi: 10.4103/1673-5374.291381. DOI: https://doi.org/10.4103/1673-5374.291381
Mohan A, Kumar R, Kumar V, Yadav M. Homocysteine, Vitamin B12 And Folate Level: Possible Risk Factors in The Progression of Chronic Heart and Kidney Disorders. Current Cardiology Reviews. 2023 Jul; 19(4): 66-83. doi: 10.2174/1573403X19666230209111854. DOI: https://doi.org/10.2174/1573403X19666230209111854
Mehta R, Daude A, Variava E. Vitamin B12 Deficiency and Hyperhomocysteinemia: A Description of Two Cases with Thrombosis. Wits Journal of Clinical Medicine. 2022 Jul; 4(2): 103-6. doi: 10.18772/26180197.2022.v4n2a6 DOI: https://doi.org/10.18772/26180197.2022.v4n2a6
Hoteit M, Khadra R, Fadlallah Z, Mourad Y, Chahine M, Skaiki F et al. Prevalence and Time Trends of Low Serum B12 Levels and Inadequate B12 Dietary Intake in Lebanese Adults Amidst the Food Insecurity Situation: Findings from A Nationally Representative Cross-Sectional Study. Nutrients. 2024 Jan; 16(2): 226. doi: 10.3390/nu16020226. DOI: https://doi.org/10.3390/nu16020226
Jiang B, Chen Y, Yao G, Yao C, Zhao H, Jia X et al. Effects of Differences in Serum Total Homocysteine, Folate, And Vitamin B 12 On Cognitive Impairment in Stroke Patients. BMC Neurology. 2014 Dec; 14: 1-5. doi: 10.1186/s12883-014-0217-9. DOI: https://doi.org/10.1186/s12883-014-0217-9
Zhou L, Wang J, Wu H, Yu P, He Z, Tan Y et al. Serum Levels of Vitamin B12 Combined with Folate and Plasma Total Homocysteine Predict Ischemic Stroke Disease: A Retrospective Case-Control Study. Nutrition Journal. 2024 Jul; 23(1): 76. doi: 10.1186/s12937-024-00977-7. DOI: https://doi.org/10.1186/s12937-024-00977-7
Gospodarczyk A, Marczewski K, Gospodarczyk N, Widuch M, Tkocz M, Zalejska-Fiolka J. Homocysteine and Cardiovascular Disease—A Current Review. Wiadomosci. Lek. 2022 Jan; 75: 2862-6. doi: 10.36740/WLek202211224 DOI: https://doi.org/10.36740/WLek202211224
Mutavdzin SS and Djuric DM. Homocysteine and Related B Vitamins in Pre-Diabetes and Diabetes Mellitus. Biochemistry Of Cardiovascular Dysfunction in Obesity. 2020: 329-51. doi: 10.1007/978-3-030-47336-5_17. DOI: https://doi.org/10.1007/978-3-030-47336-5_17
Huang S, Cai J, Tian Y. The Prognostic Value of Homocysteine in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis. Frontiers In Systems Neuroscience. 2021 Feb; 14: 600582. doi: 10.3389/fnsys.2020.600582. DOI: https://doi.org/10.3389/fnsys.2020.600582
Devi P. Vitamin B12 Status and Its Impact on Cardiovascular Risk Factors: Insights from A Hospital Based Cross-Sectional Study. Int J Acad Med Pharm. 2023; 5(5): 1160-4.
Pinzon RT, Wijaya VO, Veronica V. The Role of Homocysteine Levels as A Risk Factor of Ischemic Stroke Events: A Systematic Review and Meta-Analysis. Frontiers In Neurology. 2023 May; 14: 1144584. doi: 10.3389/fneur.2023.1144584 DOI: https://doi.org/10.3389/fneur.2023.1144584
Yuan S, Mason AM, Carter P, Burgess S, Larsson SC. Homocysteine, B Vitamins, And Cardiovascular Disease: A Mendelian Randomization Study. BMC Medicine. 2021 Dec; 19:1-9. doi: 10.1186/s12916-021-01977-8. DOI: https://doi.org/10.1186/s12916-021-01977-8
Wolffenbuttel BH, Heiner-Fokkema MR, Green R, Gans RO. Relationship Between Serum B12 Concentrations and Mortality: Experience In NHANES. BMC Medicine. 2020 Dec; 18: 1-4. doi: 10.1186/s12916-020-01771-y. DOI: https://doi.org/10.1186/s12916-020-01771-y
Manapurath R, Strand TA, Chowdhury R, Kvestad I, Yajnik CS, Bhandari N et al. Daily Folic Acid And/Or Vitamin B12 Supplementation Between 6 And 30 Months of Age and Cardiometabolic Risk Markers After 6–7 Years: A Follow-Up of a Randomized Controlled Trial. The Journal of Nutrition. 2023 May; 153(5): 1493-501. doi: 10.1016/j.tjnut.2023.03.003. DOI: https://doi.org/10.1016/j.tjnut.2023.03.003
Al-Ma’aitah A and Tayyem RF. Vegetarian Diet: Health Implications and Nutrients' Adequacy. Pakistan Journal of Nutrition. 2020: 1-9.
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